Laserfiche WebLink
CITY OF SANTA ANA <br />PROJECT NO. 13 -7513: EL SALVADOR PARK WALKWAY RECONSTRUCTION <br />PROJECT NO. 13 -7514: WINDSOR PARK WALKWAY RECONSTRUCTION <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action <br />2. Status of Federal Action <br />3. Report Type: <br />❑ a. Contract <br />❑ a. Bid/offer /application <br />❑ a. initial <br />b. Grant <br />b. initial award <br />b. material change <br />c. Corporate Agreement <br />c, post -award <br />d. Ban <br />For Material Change only: <br />e. Loan Guarantee <br />Year quarter <br />f. Loan Insurance <br />date of last report <br />4. Name and Address of Reporting Entity <br />5. If Reporting Entity in No. 4 is Subawardee, Enter Name and <br />Address of Prime: <br />❑ Prime ❑ Subwardee <br />Tier , If known <br />Congressional District, i known <br />Congressional District, i known <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description <br />CFDA Number, If applicable <br />8. Federal Action Number, jAnown <br />9. Award Amount, if known <br />10. a. Name and Address of Lobbying Entity b. Individual Performing Services (#rht ag aatimss fa fr=Na 10q) <br />0LWnwr,#gAV (lastnfy9 AV <br />attach Continuation Sheet(s) if necessary) <br />11. Amount of Payment (check all that apply): <br />13. Type of Payment (check all that apply) <br />$ ❑ Actual ❑ Planned <br />❑ a. retainer <br />❑ b. one -time fee <br />❑ a commission <br />12. Form of Payment (check all that apply): <br />❑ a. cash <br />❑ d. contingent fee <br />❑ b. in -kind; specify: nature <br />❑ e. deferred <br />value <br />I ❑ f other, specify <br />14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for <br />Payment indicated in item 11: <br />attach Continuation Sheets i recess <br />15. Continuation Sheet(s) attached: D No <br />16.Inmra6mmWestoddmtoltris fam ismkri2edbyT#ie31 USC Sec im <br />1352 Thisdisdoaaeoflobbyingacar�isanx4n l moffactupm <br />Signature <br />whichmhanoewaspWMb) d ticr*mwtendbetmsac imwmnm&cra*ed <br />\ n <br />Print Name -� {z� �( I" \ (��} SS / <br />inb. Thiis&domisregiWpL t1o31US.C.1352 Thisinibnr�onw�lbe <br />repottadbtbeCcngtesssm i arxnrallyandwMbemailableforpti) icinspection. <br />E S I %j J <br />Any pesonv& fatlsbfiledremoeddscimnshall bewbjec #bacivi1penaltyof <br />Title (=f <br />mtlessdran$ 10, 000ardmtrmtedmn $100,000foreachsxhfiuliae <br />S 7 7 8 <br />Telephone No. i 8 $ 3 — Date Iq n1 _ 2 _ z 0 13 <br />Federal Use <br />Autlronzed for Local Reproduction <br />Standard Form —LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 24 of 30 <br />